68例妊娠合并血小板减少的临床分析

摘要

目的探讨妊娠合并血小板减少的原因和妊娠结局。方法回顾性分析新疆医科大学第一附属医院2009年1月-2011年12月68例妊娠合并血小板减少患者的临床资料。根据不同病因分为4组：妊娠相关性血小板减少（PAT）组、妊娠高血压疾病（PIH）组、特发性血小板减少性紫癜（ITP）组及其他组（包括巨幼红细胞贫血、白血病、系统性红斑狼疮等）。有出血倾向或血小板计数＜50×109/L患者给予糖皮质激素或免疫球蛋白或输血小板治疗。结果68例患者中妊娠相关性血小板减少（PAT ）41例（60．3％），妊娠期高血压疾病（PIH ）16例（23．5％），特发性血小板减少性紫癜（ITP）6例（8．8％），其他病因5例（7．4％）。剖宫产50例，阴道分娩18例，产后出血4例，新生儿颅内出血2例。PAT和PIH组患者产后42 d血小板与治疗前比较差异有统计学意义（P ＜0．05），ITP及其他原因患者产后42 d血小板与治疗前比较无明显差异（P＞0．05）。结论妊娠合并血小板减少的不同病因中，妊娠相关性血小板减少最多见。对血小板计数＜50×109/L或有明显出血倾向者，根据孕周不同给予糖皮质激素、免疫球蛋白和（或）输血小板治疗。血小板计数≥50×109/L如无产科指征，可经阴道分娩，如手术终止妊娠应在术前输注血小板后行剖宫产术。%Objective To explore the etiology and the outcome of pregnancies complicated with thrombocy-topenia .Methods 68 cases of pregnant women complicated with thrombocytopenia were retrospectively studied from January 2009 to December 2011 .68 cases were divided into 4 groups .They are pregnancy-as-sociated thrombocytopenia (PAT ) group ,hypertensive disorder in pregnancy (PIH ) group ,idiopathic thrombocytopenia group and a group with other blood dieases .Glucocorticoids and (or) immunoglobulin G are given to those with platelet count less than 50 × 109/L .Results There were 41 cases (60 .3% ) ,16 ca-ses (23 .5% ) ,6 cases (8 .8% ) and 5 cases (7 .4% ) induced by pregnancy-associated thrombocytopenia (PAT) ,hypertensive disorder in pregnancy (PIH) ,idiopathic thrombocytopenia and other reasons ,re-spectively .Vaginal delivery and cesarean section were performed in 18 and 50 cases .The platelet count of PAT patients and PIH patients were different after delivery (P < 0 .05) .Conclusion Reasons that can cause thrombocytopenia during pregnancy are diverse .PAT is the most common type .Glucocorticoids and (or) immunoglobulin G are given to those with platelet count less than 50 × 109/L .Platelet transfusion may be considered before or after delivery to prevent hemorrhage when platelet count is still less than 50 × 109/L .Caesarean delivery should be performed after infusion of platelet concentrate in those platelet <50 × 109/L .In patients w hose platelet ≥50 × 109/L ,transvaginal delivery can be chosen if there is no obstet-rical indication .